>>Good morning. I'm Nancy Brown,
chief executive officer of the American Heart Association. Welcome to the launch of the new 2020 CPR & ECC CPR guidelines. Since the first CPR
guidelines were American Heart
Association has consistently
reviewed, updated and
published new guidelines to
ensure that the highest quality
care for the people who
need it most. We are the first
and only United States training organization directly involved in creating resuscitation
science and education. Our evidence-based
approach to resuscitation
is driven by our global volunteer
network of science experts
who help guidelines used
by all US training organizations. The pandemic has
brought many challenges to
the forefront, but in true fashion, the American Heart
Association has rapidly responded. We are protecting
the medical heroes on the
front lines, providing oxygenation
and ventilation training
to help health care
providers that treat COVID-19 patients while also offering
a hybrid of resuscitation
refresher courses. We launched an online adaptive learning of patients
with suspected or confirmed COVID-19, making the first time an e-learning resource was
introduced at the same time as a new guideline. And through our
QI partners we issued we can help, a digital resuscitation education crisis
response program program. No-one should be in
doubt with the American Heart
Association by their side. We have unmatched
leadership in resuscitation research, science and
education, and our bold advocacy
continues to advance quality
care. were made for
this moment, and the results
reflect the determination
and dedication of volunteers, donors, supporters and
our staff. Today you'll
hear from many scientific experts
about the up updated guidelines,
which not only address health disparities but also transform opioid-related emergencies and
the physical and emotional
recovery after cardiac arrest. Together we will be bold. Together we will demand change. will demand change. We will swap
challenge for opportunity. world of longer,
healthier lives. It is now my pleasure to introduce Dr Peter to kick
us off this morning. Thank you for joining us. >>Welcome, everyone,
to the American Heart Association's 2020 guidelines virtual experience. We are so excited to have
so many of you joining us
today across the US and
internationally. resuscitation
science and education and
the producer of the official CPR and emergency cardiovascular care guidelines, we are proud to present
highlights of the 2020 guidelines during our first
session of the day. I'm Dr Raina
Merchant, an associate professor of emergency medicine
at the University of
Pennsylvania and chair of
the Emergency Cardiovascular
Care Science & Innovation committee. Together with
Dr Dr Peter morally, we'll
be starting morally, we'll
be starting overview of how
the official AHA guidelines
for CPR & ECC are developed. I'll then turn
it over to our colleagues,
the chairs and vice-chairs of the guidelines writing
groups, to present 2020's recommendations
for adults, pediatrics, neonates, resuscitation
education and systems of care. Before we get into
the detailed highlights, you're
probably wondering what's new. Some of the key
changes that we'll cover in more
detail throughout the we'll cover in more
detail throughout the added to inhospital
and out of hospital chains of survival, new recommendations
for treating opioid overdose
and cardiac arrest in preg
pregnancy, important updates
addressing disparities and CPR training, a
reaffirmation of epinephrine,
an increased ventilation rate for pediatrics. I'm going to turn it over
to Dr Morally. was formed in 1992 and currently its membership consists of the key guideline producing
council throughout the world, including the
American Heart Association. Its vision is to save more
lives globally through resuscitation
and its mission
is to promote, disseminate and advocate international
implementation of evidence-informed resuscitation
and first aid, using transparent
evaluation and consensus summary of scientific data. scientific data. filled with
international volunteers and
representing advanced life-support,
basic life-support, education implementation
and teams, first aid, pediatric life-support
and neonatal life support. It publishes advisory statements from 1997, then every
five years from 2000 through
to 2020, published today. I have the privilege
of sitting on the board and the
honor to chair ILCOR's scientific
advisory committee. The ILCOR task
force creates consensus on science statements with
treatment recommendations. This science and
recommendations are used by
the guideline rating organizations
such as the American Heart Association to
produce their detailed resuscitation guidelines. This process moves from right
to left. It starts with a topic, which is formulated
into an answerable question, and then a detailed
review of the scientific
evidence is conducted conducted. The studies identified
by the review are catalogued. The process to produce this evaluated hundreds of studies. In this way a detailed reference
list is created. The information from
the studies identified by this review is then
carefully analyzed and combined using a
standardized approach. The overall evidence
evaluation process follows
a detailed methodological methodological
structure. The reviews are
based on the methodological
principles published by
the national medicine, the
cock Cocrane library and
recommendations by Prisma. Three main categories were
conducted for the 2020 guidelines. The first is
the traditional methodologically
rigorous systematic review
process. Predominantly
for questions regarding questions
but also regarding diagnostic
tests and prognosis. Consensus on science statements and treatment
recommendations reviews. The second is scoping review. This was used when a
broad question was asked to
explore what literature is actually available and
to establish whether a system
systemic review should
be conducted. The finally type was the evidence update. An international expert conducted a
limited search of a particular
literature and summarized their findings, again
establishing whether or not a formal systematic review
should be conducted. Many of the systematic and scoping reviews have now been published in the peer-reviewed
literature and the key components
of the three types
of reviews are included in the
detailed ILC ILCOR consensus
on treatment recommendations and appendices that are published today. The information
from these 83 systematic reviews, 31 scoping reviews and 71 evidence updates
forms the scientific foundation
from which resuscitation guidelines are created Back to you, Raina. >>Thank you, Peter, for the overview. This figure illustrates
the process of how a research
question from the AHA communities
moves through several steps to ILCO ILCOR and
AHA writing groups to eventually
become a guideline. The recommendations
are then assigned a class to delineate the
strength of the recommendation
and then a level to delineate the quality of evidence. Out, Out, identify clinical
efficacy, help with ease of implementation, and take into account
local systems factors to support
adoption. The AHA translates the guidelines into resuscitation
education and training to ensure that students receive the highest-quality
knowledge and skills. I'm going to turn it over
to the doctor to provide highlights
from the adult section. >>Thank you, raina. I'm joined by Dr Kate today. Dr Kate today. release of the up
updated adult AHA guidelines and to
showcase all the hard work of the whole
committee. The 2020 adult
AHA guidelines are directed
at providing you a comprehensive
look at cardiac arrest care. Our work spanned the full spectrum of the chain of survival, including bystander interventions, pre-hospital
management and cardiac arrest
care in both the ED and the
inhospital setting, both before and after ROSK. In these guidelines, following a evaluation,
we present 250 evaluation,
we present 250 new and updated
guidelines. The total top
ten take-home messages of the adult section does
a good job of describing the overall highlights of
the updated guidelines. One of the most exciting aspects of the comprehensive
evaluation was that, once again,
we're able to reaffirm the
key aspects of resuscitation. These include the
importance of high-quality
CPR and early defibrillator
for shockable rhythms. This is mirrored in our BLS algorithm. In the BLS algorithm,
you see the focus of early recognition and CPR initiation with early defibrillator. So here you see early recognition
at the top, and of
course the use of CPR and early de >>An advanced life-support in addition to these cornerstones,
we reaffirm the importance of epinephrine epinephrine. Due to data from a large trial showing improved survival with
epinephrine, particularly those with non-shockable rhythms we emphasis the
importance. In the algorithm
we have given visual cue to prompt the importance of giving epinephrine as soon as possible specifically
with patients with
non-shockable rhythm. rhythm. >>One important issue in resuscitation
is issue in resuscitation
is events are not
identity. To have optimal patient outcome, many situations require specialized management, depending
on the event itself. In these guidelines, we present a number of special circumstances with
recommendations for resuscitation. As an example, we present new algorithms for the management of
cardiac arrest in pregnancy and opioid associated cardiac
arrest. Concerning cardiac
arrest in pregnancy, we
highlight the to optimize outcomes
during to optimize outcomes
during arrest. Additionally, we stress the importance of uterine dis
displacement and delivery. Concerning cardiac arrest
we recognize the large burden
of disease from the opioid
epidemic and the increased rates of cardiac arrest. Therefore, in this
guideline we feature an in-depth
evaluation of the literature
on an opioid associated cardiac
arrest. We present new
algorithms which leverage
the rigorous evidence evaluation
of a new scientific statement on opioid associated
cardiac arrest. For parities who it's increasing understood
that optimizing care has a significant impact on functional outcome. In recognition of this importance we present an updated algorithm
for care that describes both the initial stabilization as well as important
aspects of critical care
interventions in the few days after cardiac arrest. These include temperature management,
EEG management optimum patient outcome. Then a particularly important part
of care is neuroprognostication. We feature a detailed evaluation of
the updated evidence based
on multiple exhaustive systematic reviews done by ILCOR. Due to the importance
of timing and a multi-modal
approach, we've created a new schemeatic to guide providers that
provides an overview of the key prognostication,
including biomarkers, as well as guidance on timing for optimal prognostication. >>Finally, and possibly one of the most
important changes is the
recognition of recovery as
a key aspect of the chain
of survival. We have worked
diligently to improve outcomes
and now we need focus on
the care of our survivors. In this guideline
we leverage a new scientific statement on survivorship
and recognize that recovery
is a process that requires organized planning to optimize a planning to optimize a patient's outcome
as they transition home
home, making recovery a key
aspect of our everyday care. Hopefully this discussion
provided a small idea of the comprehensive
nature of the 2020 adult guidelines. We're excited
to bring these guidelines forward
and to continue to improve
outcomes in our community. We'd now like to welcome
doctors to the virtual stage
to present updates for pediatric resuscitation. >>Thanks. >>Thanks. TNI on behalf of the AHA pediatric writing
group are thrilled to
talk about the highlights from
the AHA 2020 pediatric basic and life-support guidelines. We'll focus
on CPR, airway management and
post-duress care. While no specific changes were made to the recommendations
regarding the performance of chess compressions in the 2020 guidelines,
we continue to highlight and
emphasize the critical importance of high-quality CPR with a focus on providing
adequate minimizing
interruptions and allowing for full chest allowing for full chest recoil. >>For pediatric patients in any
setting, it is reasonable
to administer the initial dose of epinephrine within five minutes from
the start of chest compression. This is a change
from the prior guidelines which did
not specifically state a time frame. Studies of pediatric
inhospital cardiac arrest have demonstrated that children who receive epinephrine
for an initial minute delay in administration of epinephrine epinephrine, there was a significant decrease in
ROSC, survival at 24 hours, survival to discharge and
survival with favorable neurologic outcome. Studies of pediatric out
of hospital cardiac arrest
demonstrated that earlier epinephrine administration increased rates of ROSC,
survival to ICU admission,
survival to dis discharge and 30-day survival. >>The opioid epidemic has not spared children. children. contain new
recommendations children with
respiratory or cardiac arrest
from opioid overdose. These are extrapolated
from the adult guidelines as
no specific pediatric data were reviewed. For children in respiratory arrest,
standard pediatric basic
or advanced life-support
measures should be implemented. In addition, it
is reasonable for responders
to administer naloxone. Even if opioid overdose is
suspected, the overdose is
suspected, the focus should be on focus should be on ventlations and
should take place with the administration
of naloxone. >>When performing CPR in infants and children
with an advanced airway,
it may be reasonable to target a respiratory
rate range of one breath every two to three seconds,
or 20 to 30 breaths per minute, accounting for age and clinical condition preponderates exceeding these recommendations
may compromise hemodynamics. This is a change
from the previous guidelines,
which recommended for the intubated child a ventilation
rate of about one breath every
six seconds or ten times per minute without interrupting
chest compression. New data suggest that higher ventilation rates,
at least 30 breaths per minute in infants less
than one year of age and at least 25 breaths per minute
in older children, are
associated with improved rates of return
of spontaneous circulation and
survival in pediatric in inhospital cardiac arrest. and children
-- (inaudible) One breath every two to three seconds
or 20 to 30 breaths per minute. This is a change from
the prior guidelines which recommended giving
rescue breaths at a rate of about 12
breaths per minute. Although there are no
data about the ideal ventilation rate for
children in respiratory arrest, with
or without an advanced airway, for simplicity training, the simplicity training, the respiratory arrest situations. Do not underestimate bag mask ventilation. For out of hospital cardiac
arrest, bag mask ventilation
results in the same
resuscitation outcomes as advanced
airway airway interventions
such as trackial intubation. trackial intubation. >>Previous guidelines recommended either
a cuffed or uncuffed and trackial tube for infants and children. In this outbreak date we recommend
attention to tube size,
position and cuff inflation pressure. Data support
that when cuff tubes are used there's a decreased need for reintubation
and stenosis is rare. For the 2020
guidelines, the routine use
of pressure is not recommended during tracheal intubation of pediatric patients. pediatric patients. This is This is supported by
new data that the routine use
of pressure reduces intubation
success rates and does
not reduce the rates of re regurgitation. >>The pediatric tachycardia
with a pulse algorithm does not include the words
profusion in the title. Rather, the algorithm
is now for all tachycardia with a
pulse and the assessment of whether the
patient has cardiopulmonary
compromise signified by
altered mental status, signs
of shock or hypoperfusion, is now immediately
assessed after the initial
assessment and support of the
airway and presence of a pulse is confirmed. After the rhythm is assessed
by a 12 lead E ECG monitor, rather than focusing first
on whether the rhythm is wide or narrow, the focus
is now on the clinical status of
the patient and whether they have cardiopulmonary compromise. Based on whether the patient
does or does not have cardiopulmonary
compromise, the duration
of the QRS is then identified to help decipher super
ventricular tachycardia from
ventricular tachycardia and further treatment. >>The resuscitation
is not over with return
of spontaneous circulation. For all patients we
should prevent and treat hypotension, hypocap gnaw,
hyperoxia and hypoxia. For children who do not regain
consciousness, we recommend
using either targeted temperature targeted temperature followed by 36 to 37.5 degrees Celsius
or TTM of 36 to 37.5 degrees Celsius. Seizures, including non-conyou will
have assist, are common after cardiac arrest and cannot be detected without EEG. When resources
are available, continuous EEG
monitoring is recommended for the detection of seizures in patients with persisting encephalopathy
after cardiac arrest. This is associated with poor outcome and treatment is
beneficial on a general pediatric population. It is now recommended
to treat clinical seizures in children following
cardiac arrest, as well
as to treat non-con non-conyou will
have assist following cardiac arrest in
consultation with experts. Finally, prognosis for patients who receive therapeutic hypothermia should be delayed
until 72 hours after rewarming to increase the
likelihood of accuracy. For 2020, we have now created
a post-cardiac arrest care checklist in order to provide
clinicians with an accessible
approach following cardiac
arrest. >>To highlight these different aspects
of cardiac arrest management, the pediatric chain
of survival has been updated. A separate out of hospital chain of survival
has been created to distinguish
the differences
between out of hospital and in hospital cardiac arrest. In both the out of
hospital cardiac arrest and inhospital cardiac arrest chains, a sixth link has
been added which focuses
on short- and long-term treatment evaluation and
support for survivors and their families. It is recommended that pediatric cardiac arrest survivors be
evaluated for rehabilitation
services. It is reasonable to refer pediatric cardiac arrest survivors for ongoing neurologic evaluation
for at least the first
year after cardiac arrest. There is growing
recognition that after cardiac arrest, survivors can
have physical, cognitive and emotional challenges and may need ongoing therapist and interventions. Survivors of cardiac arrest
may require ongoing integrated
medical, rebel rebeltative,
caregiver and community
support in the months to years
after their cardiac arrest. Next up, to discuss the updates for neonatal resuscitation, we're pleased
to introduce Dr Aziz and Henry Lee. >>Thanks. Hello. Hello. >>Hello. I'm Henry Lee, associate I'm Henry Lee, associate professor of
pediatrics and neonatology at
stand forward University, with my colleague we're happy to present the work
of the AHA writing group for the neonatal guidelines. The 2020 neonatal
Russ Russ guidelines follow
the steps of the algorithm
which is unchanged from 2015. needs of every
newly born baby and proceeds
to address the needs of
babies who are at risk for or have card crow respiratory
compromise. Approximately
10 per cent of newborns need help with breathing at birth. To address this,
clinical teams need to anticipate
the need for resuscitation while training and preparing appropriately. should be attended by at least one trained
individual dedicated to
the immediate care of the
newborn, with arrangements
for immediate assistance from others. We reaffirm that
most newly born infants
do not require immediate cord
clamping or resuscitation
after birth. Healthy newborn
infants can be evaluated
and monitored while enjoying
skin-to-skin contact with
their mothers after birth. outcomes, such
as parental bonding and
breastfeeding. In Inflation
and ventilation of the lungs remains a priority for caregivers providing immediate
neonatal care. In regard to babies who are born through
my coneium fluid, clinical trials suggested that
the presence of the fluid
does not change neonatal care. After birth, perform the initial
steps by providing warm and positioning the
baby, and if respiratory support is indicated, provide
effective positive pressure ventilation and
then perform corrective steps as necessary. obstruction is evidence. >>A rise in heart rate remains the
most important indicator of
effectiveness of ventilateory
support and response to your interventions. More data emerge suggesting
that elect cardiography is the most reliable way to detect. Pulse oximetry
is used to meet oxygen saturation goals. The indications for chest compression
remain the same in 2020,
based on poor response to ventilation
with appropriate corrective measures. The rate of chest compression
remains 90 per minute, synchronized
with 30 lung inflations
per minute. The umbilical
venous route is the preferred
method for epinephrine and volume administration. Outside the delivery rooms, comfortable
with IO access and this is a reasonable alternative. Evidence suggests that
survival is unlikely if, during resuscitation,
heart rate remains unrecordable
after more than 20 minutes of continued
resuscitation. It is recommended that this approximate meat
time frame be used to initiative discussions
with the care efforts. We recognize many of
our recommendations mirror those
from previous years. Through an extensive process of review,
including systematic scoping and evidence reviews;
we have reappraiseed past and present evidence
to refine our guidelines. Some recommendations
are stronger or better supported. We have also made
suggestions where evidence
is weak and further research
is required and encouraged. We have identified many
gaps in our current knowledge,
including team composition and training, devices used during resuscitation, special newborn
populations, such as extremely
preterm babies and those with congenital cardiac or respiratory anomalies. Our next presentation
focusing on updates to
resuscitation education, will
be led by our colleagues
Adam Chang and Aaron Donahue. >>Aaron and I are pleased to present the education science portion
of the 2020 our writing group. In 2013, ILCOR published
the formula for survival
which described three key components contributing to survival from cardiac
arrest arrest. In these guidelines we describe evidence
supporting the importance of educational efficiency, topics related to instructional design and individual provider considerations. Instructional design features are the key ingredients
of education. They determine how educational programs are designed and delivered. instructional design features, one specialty topic and an
additional four topics related
to provider characteristics
and access to education. First, let's discuss four
instructional Stein features
that, when implemented, have proven benefits for enhancing resuscitation skill acquisition. Deliberate practice is a training approach where
learners are given a discrete goal to achieve, immediate
feedback on their performs
and ample time to improve
performance. It includes testing that includes a set
of criteria to define a specific
passing standard. Our review of the
literature showed that the majority of studies
using these approaches improved learner
performance during simulated
resuscitation. We recommend incorporating deliberate practice and relearning into
basic and advance life-support
courses with a focus
on providing learners sufficient opportunity
for deliberate practice and
ample time to attain the minimum
passing standard required for a specific skill. Currently most
resuscitation courses use a
mass learning approach approach,
a single training event
lasting hours or days days, with retraining every
one to two years. Booster training is thorough instructional design feature involving brief weekly or monthly sessions focused on repetition of
content that was initially presented during the mass learning course. Frequent booster training at intervals
of one with improved long-term In these guidelines,
we make a class is
recommendation to implement booster
sessions when utilizing
mass learning approach for
resuscitation training. A space learning
approach involves a separation of course content
into multiple training sessions, each lasting minutes
to hours, with intervals
of weeks to months in between
sessions. Space learning
courses are of equal or greater effectiveness than mass learning courses for pediatric resuscitation training. More research is required to
compare space learning with
mass learning for advanced
life-support, neonatal, and basic life-support. Given the evidence that we have in pediatrics, we
believe it is reasonable to
learn a space learning approach
in place of a mass learning
approach for resuscitation
training. CPR feedback
devices provide objective feedback
on CPR performance during
practice. Correct Corrective
feedback devices provide a visual display or auditory prompting for
CPR quality relative to desired
targets. relative to desired
targets. This allows
the learner to adjust their compression depth, rate
and recoil to meet AHA guidelines. The use of corrective CPR feedback devices during training resulted in improved skill
performance at the end of
training and up to three
months later. As a majority of studies demonstrate positive
effects of CPR feedback devices during training,
we've made a class 2
recommendation for the use of these devices during training. >>The next several recommendations
will deal with how to enhance resuscitation
training and afterwards how
to enhance training in CPR for lay people. The use of team work training has been a part of AHA courses
for more than ten years and it's
based on the recognition that such things as leadership,
communication and role clarity
enhance the way teams work and their performance in
resuscitation exercises. Based on our review of the
literature, we make a two-way recommendation
specific to recommendation
specific to team work training
be a part of life-support
courses in that it can yield better learning outcomes among learners who receive it. The term infidelity
is used to refer to the physical features used
in training courses. These mannequins have
come to exist across the age range and in a variety of other
states over the past several
decades. We balance these recommendations with the recognition that
using them personnel as
well as costs, two-way classes that enhance training and in their absence
lower fidelity mannequins can
be used and it's reasonable
to use them for enhancing
resuscitation training. In C 2 training refers to learners
who under undergo resuscitation training
in their native clinical environments
as opposed to in a classroom or a simu
simulation laboratory. The theoretical benefits
are enhanced realism and enhanced contextual pertinence to contextual pertinence to trainees when undergoing trainees when undergoing these sessions. these sessions. a class 2A
recommendation that the use of insuchu training may
be beneficial and that it can replace classroom-based
training for resuscitation education. Lastly, gameified
learning refers to the
use of such things as competitive leaderboards when using resuscitation training assessments, and virtual reality refers to use of immersive 3-D
environments. These are relatively new fields in resuscitation education but reviewable literature leads
us to make recommendations
that the use of gameified
learning and/or virtual reality may be considered for basic and enhanced life-support to enhance learner
outcomes. The next recommendations have to do with
CPR training in the lay population
and it's important
to note this set of recommendations
-- (inaudible)
strongest ones we provide based on the realization that for all these recommendations
the risk. First, with regard to lay training,
we recognize that self-directed CPR training overcomes
obstacles in terms of ease
of use and cost and we
make a class 1 recommendation that
self-directed CPR training be used
in addition to standardized
training for layperson learners
and it may be a reasonable replacement for
traditional classroom or instructor Guyeded learning. The second has
to do with the training of
young people. We know from
studies that children as young as 10 effective chest
compression to adult mannequins
and we give a class 1
recommendations that all students in middle and
high school undergo training to provide
high-quality CPR in the hopes this
will lead to a broader pool
of bystander CPR providers in the community. Finally, we are increasingly recognizing that CPR training, CPR readiness and
the prevalence of bystander
CPR varies from areas in our
society related to ethnicity, race, socio-economic
status and socio-economic
status and We strongly recommend
that targeted training be provided to neighborhoods
or communities based on race
or based on ethnicity to
target higher risk or more underserved populations. Additionally, we recommend that it is reasonable to address barriers to
bystander CPR for female cardiac
arrest victims through
the use of educational training and public awareness
efforts. >>Thanks, Aaron. In developing these
guidelines for resuscitation
education, we've identified
several key opportunities to help advance our field moving forward. These include defining and
standardizing outcomes of clinical relevance, establishing links between
performance outcomes in training and patient outcomes,
both of which will help us to solidify the
importance of effective resuscitation training for patient survival. More research is required to
establish the cost-effectiveness of various different
training interventions
and we see a pressing need
for research pressing need
for research describing how to tailor describing how to tailor features to key resuscitation skills. We view these guidelines
as a road map and
we encourage resuscitation
educators to review the
recommendations and reflect on
opportunities within their
own training programs to enhance educational efficiency. For our final science update we welcome our colleague Kate to cover updates for systems
of care. >>Thank you, Adam. The systems of
care working The systems of
care working group is a little
distinct from some of the others, includes input
from all the other working groups and also rather than
looking at the benefit
of a specific intervention at the individual patient
level it looks at the
most efficient way to deliver the interventions
we know are beneficial to as many patients as possible. A brief overview
of our top ten take-homes. First we talk about the
important new recovery link and I
know that's been addressed earlier
in this session. We have several
recommendations looking at various ways to
improve the -- or increase the percentage
of cardiac arrest layperson CPR
or lay rescuer CPR. We look at the importance of
early warning symptoms. Then we look at a couple ways of
using our own data to improve our outcomes. Both at the individual
resuscitation event level using
debriefing and with participation
in cardiac arrest
registries. We look at the
cognitive aid data for resuscitation
both for lay rescuers
and health care providers
and review the evidence for cardiac arrest centers
the benefit remains unproven. When I think of the
evidence for improving the number of patients who
get lay rescuer CPR I break it down into interventions before
the arrest happens and then during the
arrest itself. Before the arrest
happens we have recommendations
around ways to improve
the number of people in
the community who are primed
and ready and trained to perform
CPR and say it may be
reasonable for communities to
implement multiple strategies for
increasing awareness of strategies for
increasing awareness of cardiac arrest
and delivery of bystander CPR. This is through
both in-person training events,
instructor led training
includes mass media campaigns and self-directed
learning as was highlighted in the previous section. Then we also have a strong recommendation
for public access to defib ration programs particularly in communities that are at increased risk
for out of hospital cardiac arrest. During an arrest
event we review the data for tele telecommunicators and telecommunicator CPR instructions
and multiple studies have
shown that when a tele telecommunicator, dispatch, instructs
a lay rescuer who calls
911 how to recognize cardiac
arrest, the number of people who receive it goes up. As we all recognize
the incredible importance of
lay rescuer CPR, this is a strong recommendation. One of the pneumonics we
highlight for tele telecommunicators
who use when working with a caller is the
no, no, go. Is the patient
conscious? Is the patient
conscious? No. No. When you have people who are trained
but want to get the right person to
the right place at the right time, people have
increasingly with the ubiquitous nature of
cellphones have started using mobile
app technology to alert lay
rescuers to the presence of a cardiac
arrest victim and their location as well as the
location of the closest AED. These programs alert
people who subscribe to the app to a cardiac
arrest in their area and tell them where it is
and how to get the tell them where it is
and how to get the closest AE AED. There have been a couple
of trials done primarily in Europe and urban
centers that he have shown these programs can
get people to receive CPR quicker and also to
earlier defibrillation. These studies have not
yet shown a true survival benefit but I
think it's promising data and it remains to
be seen whether these apps will be as useful
in less urban settings or in other countries
as well. I think there's not
enough data yet to provide a
recommendation, but there are more novel
technologies such as using drones to get AED
AEDs to more remote locations that I think
are promising for the future. We've identified that
as a knowledge gap. We did review the
evidence on cognitive aides in resuscitation
both for lay rescuers and health care
providers. The data for lay
rescuers is mixed. It seems cognitive aids
help people adhere to the proper steps as they
go through it, but using such an aid may delay
the start of CPR. For that reason we've
said the effectiveness is unclear and deserves
further study before widely implemented. widely implemented. For health care
providers this is also somewhat of a knowledge
gap in the cardiac arrest resuscitation
field. There isn't a lot of
data specifically for cardiac arrest
resuscitation. We've extrapolated that
it may be reasonable to use such cognitive aids
based on the trauma literature that has
looked at this, but also somewhat of a
knowledge gap. Debriefing is increasing
increasingly recognized as important. Multiple studies have
shown that debriefing after resuscitation
events can help improve metrics and improve team
performance going forward. One thing I particularly
wanted to highlight is it seems an important
component of de it seems an important
component of de debriefing is to use objectiveive
data, not just the subjective
experience at the event but
incorporating data on chest
compression depth and rate
and whether everything was
on targets can be especially
helpful. Another way
in which using our own data can help us improve outcomes
over time is participation
in cardiac arrest registries. Studies suggest that
centers that participate
in registries and enter their
own data and look at that data
periodically, looking at tend to see improved outcomes over time. We've said it's
reasonable for organizations to do this kind of process of care evaluation. With that I'll conclude this session. On behalf of my colleagues and all
the of the American Heart Association we'd like
to thank four attending and hearing about the
updates for the 2020 AHA Care. For more information you
can go to the website ECCGuidelines.Heart.org
and to access the full guidelines. Finally we want to take
this opportunity to encourage you all to
register and attend for the American Heart
Association's first-ever virtual scientific sessions and symposium and
annual meeting coming up in November. This event will include
not only more presentations
on the guidelines but
also multiple sessions celebrating
basic clinical and
epidemiologic science in
cardiovascular and resuscitation
medicine. Thank you all
for joining us and we hope to
see you there.
